Preferred Drug List

While WellCare covers all medically necessary Medicaid-covered medications, we use a Preferred Drug List (PDL). These are the drugs we prefer that your doctor prescribe. Most PDL medications are covered without a prior authorization. Some PDL drugs are covered only with a prior authorization. Medications that require prior authorization are noted with a "PA (prior authorization), SP (specialty medication) or ST (step therapy)" listed next to the medication. The submission of a prior authorization request from your doctor is required for:

• Non-PDL drugs
• Brand name requests when a generic is available
• Requests for drugs that exceed the quantity limits
• Requests for drugs with a step therapy

Drugs that require a PA are listed on the Prior Authorization List. The prior authorization form will indicate that you need a non-PDL medicine and will explain why that medication and/or a certain amount of a medication are needed. WellCare will respond to the PA requests within 24 hours.

Transition of Pharmacy for ABD Members

ABD consumers new to managed care will be able to receive their prescription drugs with no new prior authorization requirements than traditional FFS Medicaid for the first three months they are enrolled in our plan. This means that if you needed a prior authorization under traditional Medicaid to get your prescription medication, you will most likely still need a prior authorization to get the same medication. If you have not needed prior authorization under traditional Medicaid to get your prescription medication, you will not need prior authorization from WellCare of Ohio to get the same medication for the first three months you are enrolled. This will give you and your doctor time to consider other medications that do not require prior authorization and to learn the steps to getting prior authorization. WellCare of Ohio's ABD Prior Authorization (PA) List identified all drugs that require PA once you have been a managed care member for more than three months. If you are not sure when you will need to have your medication(s) prior authorized or you have other questions about continuing to get your medication, call Member Services at 1-800-951-7719 (TTY 1-877-247-6272).

Unified ABD and CFC Prior Authorization List

Unified ABD and CFC Preferred Drug List 

 

Last modified: 08/19/2007